David Marsden, Head of Occupational Therapy at the Manchester Mental Health and Social Care Trust
Although there is a decreasing trend in fire incidents and injuries as a result of successful fire safety and prevention activity, the rate at which this figure is reducing has slowed down, it is thought because of a small group of people known by fire services as ‘people at increased risk of fire’ (PaIRoFs). In 2007 I sat down with the fire service because they had a feeling that people with mental health conditions were more likely to die in fires than others. Comparing fire deaths between 2001-2007 with Trust records we found that 37% of those who died in fires were known to mental health services in Manchester.
As a result of this we felt we had to act and subsequently agreed a formal partnership and a jointly funded post. My advice was that an occupational therapist would best placed to help the fire service think beyond the environmental cause of fire and look at the interrelationships between the person, the things they do day-to-day (occupation) and their physical and social environment with regard to fire risk and safety.
The independent evaluation of the project carried out by the University of Salford in 2011 noted that the project was a ‘successful collaboration’ and that the ‘investment to save potential for this specialist partnership are clearly measured’. Manchester Mental Health and Social Care Trust (MHHSCT) and the Greater Manchester Fire and Rescue Service (GMFRS) decided that a sustainable approach was required to maintain these outcomes and that any future approach should acknowledge that in general physical and mental health issues contributed to fire risk, not mental health issues alone. Rather than having one occupational therapist bridging the organisations we moved to training all occupational therapists in the Trust to carry out specialist occupational assessments in collaboration with the fire service staff. This was cemented in our partnership agreement.
At this point GMFRS took the positive step of recruiting a health and social care coordinator to foster similar partnerships across Greater Manchester. This happened to be Paula Breeze who was the occupational therapist employed in the pilot. In 2015 Paula and I published guidance for other health and social care providers with the aim of spreading good practice to help reduce injury and death from fire in PaIRoF groups. Key objectives included: setting up sustainable partnerships, collaboration in assessments and interventions and skill sharing.
One component of this guidance was an example of how, in Manchester, we strengthened the partnership through the use of occupational therapy role emerging placements. A key focus of the fire and rescue service currently is delivering safe and well checks, which are an expansion of the old safety checks or home fire risk assessments you may be familiar with. So when fire and rescue staff go to people’s homes they now ask about health and wellbeing and signpost where necessary. This is clearly more holistic and requires a person centred approach to engage individuals who may have a health condition or disability. Occupational therapists are best placed to assist the fire and rescue service in achieving this aim. In our experience fire and rescue service staff have responded well to our description of fire risk in terms of occupational therapy models. For example, looking at the person, their occupations and the environment and the interrelationship between these. Fire services don’t traditionally employ occupational therapists so role emerging placements have been an ideal way to support the fire and rescue service aims whilst exposing them to the added value of the profession. The university profile is inevitably raised and community relationships are improved. With the direction of travel focused on collaboration there are clearly ways health/social care, fire and rescue services and universities can support each other’s aims.
The work completed so far is not part of my role, so with the aim of sustaining our efforts nationally and spreading partnership work across the UK I recently developed a plan in collaboration with and with the support of Linda Hindle, Lead Allied Health Professional and National Engagement Lead for Police and Fire Services, the Chief Fire Officers Association, NHS England and the College of Occupational Therapists. Going forward there’s an aspiration to collaborate further and carry out research. An element of the plan is to promote the uptake of role emerging placements across the UK. There are a number of universities supporting role emerging placements into fire and rescues service in the UK. We are aware of Greater Manchester, Nottinghamshire, Dundee and Aberdeen. Feedback from fire and rescue staff and students has so far been extremely positive. As a result, I have started contacting universities via Health Education England and I’ve received a number of enthusiastic responses, from those who are starting to offer role emerging placement in the fire and rescues service and those who are interested in this area.
MMSHCT and GMFRS, with Allied Health Professionals at the centre of the design and delivery, continue working together, now in partnership with universities, to reduce the risk of fire for their service users. The two organisations have committed to share best practice nationally and have started to locate all the learning on the Health and Social Care Fire Safety web page and host further best practice sharing sessions using online platforms .
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